Workshop Registration: Causes, Effects and Behaviour Change
Presented by Mark Lamont, Clinical Neuropsychologist
Launceston 30th October 2017
Hobart 31st October 2017
Register
 
Please select your workshop session:


 
Please enter your first name:

 
Thanks {{answer_60631135}}, please enter your surname?

 
{{answer_60631135}}, what's your preferred contact phone number?

This can be your mobile, home or work number.
 
And what's your preferred email address for contact?

 
If applicable, what organisation do you work for?

 
Also, what's your address (contact or postal)?

 
The cost of this workshop is $150.00 (+GST).

On the next page, you'll select which payment option you'd like to select. This includes payment by: cheque, direct deposit or requesting an invoice.

You may wish to write or copy the following details to finalise your payment and confirm your place.

CHEQUE:
please enclose the cheque payable to: Brain Injury Association of Tasmania. This can be posted to BIAT, PO Box 4580, Bathurst Street, HOBART, 7000.

DIRECT DEPOSIT:
can be made to ANZ Bank; BSB: 017 209; Account Number: 206030942;  Account Name: Brain Injury Association of Tasmania. Please provide BIAT (enquiries@biat.org.au) with the receipt number and date paid when applicable.

INVOICE: Will be sent to the email and/or postal address provided earlier in this form.

 
Please select how you wish to pay:

Details for each payment option are on the following page.

 
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Clicking confirm at the bottom of this form will finalise your registration, which will be confirmed upon successful receipt of payment.

Thanks for your continued interest and support of workshops facilitated by the Brain Injury Association of Tasmania. Keep up to date at www.biat.org.au or www.facebook.com/braininjurytasmania.
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